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DOI: 10.1055/s-0029-1245237
© Georg Thieme Verlag KG Stuttgart · New York
Transcranial Doppler in Brain Death Confirmation in Clinical Practice
Klinische Wertigkeit der transkraniellen Dopplersonografie in der HirntoddiagnostikPublication History
received: 14.7.2009
accepted: 21.12.2009
Publication Date:
22 April 2010 (online)

Zusammenfassung
Ziel: Die transkranielle Dopplersonografie (TCD) kann in der Hirntoddiagnostik als apparative Zusatzuntersuchung angewendet werden. Ziel der Studie war die Darstellung des Nutzens der TCD zur Bestätigung des Hirntodes. Material und Methoden: Vierundvierzig Patienten mit zum Hirntod führender schwerer Hirnschädigung wurden im Verlauf von 4 Jahren untersucht. Nach klinischer Hirntoddiagnostik erfolgte der adäquate apparative Bestätigungstest entsprechend der Verfassung des Patienten und unter Berücksichtigung der Ausschlusskriterien des Studienprotokolls. Aufgrund nicht eindeutiger Ergebnisse mussten einige Patienten wiederholt untersucht werden. Ergebnisse: Von 44 eingeschlossenen Patienten hatten 19 ein Schädel-Hirn-Trauma, 11 massive aneurysmatische Subarachnoidalblutungen, 1 Patient eine arteriovenöse subarachnoidale und intrazerebrale Blutung, 12 hypertensive intrazerebrale Blutungen und 1 Patient einen ischämischen Schlaganfall. Als Primärtest wurde eine TCD bei 30 Patienten, eine Hirnszintigrafie bei 2, eine CT-Angiografie (CTA) bei 10, und eine konventionelle zerebrale Angiografie bei 2 Patienten durchgeführt. Die Diagnose konnte hiermit bei jeweils 26, 3, 9, bzw. 2 Patienten bestätigt werden. Aufgrund nicht konklusiver Ergebnisse musste die CTA bei 5 Patienten wiederholt werden. Bei den mit TCD untersuchten Patienten war die Zeitdauer bis zur Diagnosestellung am kürzesten; bei der Mehrzahl der Patienten (61 %) konnte die Diagnose des zerebralen Zirkulationsstillstandes binnen 2 Stunden nach der klinischen Hirntoddiagnose bestätigt werden. Schlussfolgerung: Die TCD ist eine Erfolg versprechende Zusatzuntersuchung zur Bestätigung des zerebralen Zirkulationsstillstandes in der Hirntoddiagnostik.
Abstract
Purpose: Transcranial Doppler (TCD) can be used as a confirmatory test in brain death. The aim was to present the usefulness of TCD in brain death confirmation. Materials and Methods: Forty-four patients with severe brain lesions leading to brain death were treated over a 4-year period. After the clinical diagnosis of brain death was made, the appropriate confirmatory test was chosen according to patient condition, taking into consideration the restrictions of the test protocol. Due to the inconclusive test results, some patients underwent repeat testing. Results: Among 44 patients, 19 had neurotrauma, 11 massive aneurysmal subarachnoidal hemorrhages, 1 arteriovenous subarachnoidal and parenchymal hemorrhage, 12 hypertensive parenchymal hemorrhages, and 1 ischemic stroke. As a primary test, TCD was used in 30, brain scintigraphy in 2, multislice CT angiography (CTA) in 10, and cerebral angiography in 2 patients, and the diagnosis was confirmed in 26, 3, 9 and 2 patients, respectively. Due to inconclusive results CTA was repeated in five patients. In patients in whom TCD was applied, the time to confirm the diagnosis was the shortest, and in most (61 %) cerebral circulatory arrest was confirmed within 2 hours of clinical diagnosis. Conclusion: TCD is a favorable confirmatory test for cerebral circulatory arrest in brain death diagnosis.
Key words
brain - testes - ultrasound Doppler
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Prof. Arijana Lovrencic-Huzjan
Department of Neurology, University hospital ”Sestre milosrdnice”, Zagreb
Vinogradska 29
10 000 Zagreb, Kroatia
Phone: ++ 3 85/1/3 76 82 82
Fax: ++ 3 85/1/3 76 82 82
Email: arijana.lovrencic-huzjan@zg.htnet.hr